Provider Demographics
NPI:1811467822
Name:EXO CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:EXO CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-464-8360
Mailing Address - Street 1:101 RICHARDSON XING
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-6006
Mailing Address - Country:US
Mailing Address - Phone:636-464-8360
Mailing Address - Fax:636-464-2180
Practice Address - Street 1:12370 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6443
Practice Address - Country:US
Practice Address - Phone:314-485-1442
Practice Address - Fax:314-485-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty